Early-Stage Prostate Cancer Rates Falling

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This study evaluates trends in prostate cancer incidence following the release of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation to not screen men 75 years or older for prostate cancer.

Note that there was an immediate decline in the incidence of early-stage prostate cancer tumors among men 75 years and older after the USPSTF recommended against screening this group consistent with a hypothesized decline in prostate cancer screening rates.

The 2008 recommendation against prostate cancer screening for men 75 and older led to a prompt decrease in the incidence of early-stage disease in this age group, a researcher found.

After the release of the U.S. Preventive Services Task Force recommendation 4 years ago, the rate of stage T1 or T2 prostate cancer among older men fell by 25.4% (P<0.001), according to David H. Howard, PhD, of Emory University in Atlanta.

There also was a 14.3% decline in stages T3 and T4 cancers (P<0.001) and a 16.8% decrease in tumors of unknown stage (P<0.001), Howard reported online in a research letter in Archives of Internal Medicine.

"Over the last decade, the evidence that screening for prostate cancer causes more harm than good has grown so much that the U.S. Preventive Services Task Force recommended in 2008 against screening for prostate cancer in men 75 years or older, and more recently, recommended against screening men of any age," wrote Mitchell H. Katz, MD, of the Los Angeles County Department of Health Services, in an editor's note accompanying the paper.

To see if the task force's recommendations had an impact on screening and incidence rates, Howard analyzed data from the Surveillance, Epidemiology and End Results (SEER) registry, adjusting for age, race, and ethnicity.

The analysis included 254,184 cases of prostate cancer.

Of these, 198,417 were stages T1 or T2, 34,695 were stages T3 or T4, and the stage was unknown for the remainder.

Among men ages 30 to 64, there were 109,053 cases, while there were 91,868 cases in the 65-to-74 age group.

The total was 53,263 for men 75 and older.

Among men 75 and older, there was a decrease in early-stage cancers between 2007 and 2009, from 443 per 100,000 to 330 per 100,000.

For late-stage tumors in this age group, there was a decrease in incidence from 83 to 71 per 100,000, and for tumors of unknown stage, the rate fell from 124 to 103 per 100,000.

Among men ages 65 to 74, the incidence of early-stage cancers decreased by 15.2%, from 697 to 591 per 100,000, according to Howard.

And among younger men ages between 30 and 64, early-stage cancers declined by 11%, from an incidence of 105 to 93 per 100,000.

"The results are consistent with the hypothesis that the revision of the USPSTF recommendations led to a small to moderate decline in prostate cancer screening rates," Howard observed.

He also noted that discrepancies in screening and physician discussions with patients continue with many men 75 and older still being screened and up to 30% of clinicians failing to discuss screening before ordering the test.

Moreover, physicians who stopped all screening for men at the age of 75 may not have explained the recommendations to their patients.

"Based on trends in prostate cancer incidence rates, the impact of the revised USPSTF recommendation on screening rates merits further investigation," he wrote.

In his editor's note, Katz further argued against screening among younger age groups.

"Given that the harms of screening (e.g., false-positive results, increased worry, treatment-related morbidities such as incontinence and erectile dysfunction) outweigh the benefits for younger men as well, we hope to see a similar decrease in early prostate cancer incidence in young men," he stated.

Less Is More is funded by the California Health Care Foundation and the Parsemus Foundation.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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